Title:

Utilization Review Specialist/Behavioral Health Substance AbuseLocation:

USA/RemoteReports to:

UR Director FLSA Classification:

ExemptFull-Time or Part-Time:

Full TimeSalary Range:

$ 60,000-62,000• Starting pay varies based on location and experience, in compliance with specific state wage regulations. Competitive rates tailored to your geography and expertise.

Position Overview:

The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies. The Utilization Review Specialist provides appropriate client information to third party payers regarding the medical necessity of treatment in a timely manner. The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed.

Key Responsibilities:

Act as agency liaison with insurance and managed care companies for authorization of treatment costs, representing company in a positive manner in the professional Participate in staff meetings as neededClear communication with supervisors, co-workers, and facilitiesKeeps abreast of changes to, and monitors compliance with, State and Federal laws and regulations in areas of insurance/ third party payersProtects the confidentiality of patients and the privacy of staffUses a computer to type correspondence, reports and other items as requested, ensuring that typing is accurateProcess data in conjunction with compliance consultants in order to present it effectively using established statistical methodsDemonstrates the willingness to accept responsibilityPerforms other duties as assigned by the

Director of Utilization ReviewQualifications:

Three to Five (5) years' experience in Case Management/Utilization Review (as either

CADC, LAADC, RN, LCSW, LPN, LMHC, LMFT, RN

Case Manager, or Utilization Review Coordinator). Prior Utilization Review experience in a Substance abuse environment is mandatory.

Knowledge of ASAM guidelines.

Knowledge of accreditation and licensure requirements (RN, LCSW, LPN, LMFT) in accordance with state agencies.

Ability to establish rapport with and supervise employees as well as professional staff and peersAbility to work under stressful conditions and is flexible in relation to department needs.

Knowledge of medical terminology.

Demonstrates proficiency in Verbal & Written CommunicationSkills.

Knowledge of State & Federal Statutes Regarding Patient Confidentiality Laws.

Knowledge of Drug-Free Workplace Policies. Knowledge of Corporate Integrity & Compliance Program.

Knowledge of state guidelines and accreditation agency standardsKIPU experience required, Best Notes experience a plusAbility to lift a minimum of 20 lbs.

Additional information: This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.

Coronis Health is committed to creating a diverse and inclusive environment where all employees are treated fairly and with respect. We are an equal-opportunity employer, providing equal opportunities to all applicants and employees regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or any other protected characteristic. We welcome and encourage applications from candidates of all backgrounds.